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India Specific Consensus Guidelines for the Management of Differences of Sexual Development
Ramesh Babu1, Prabudh Goel2, Vikesh Agrawal3
1Department of Pediatric Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.
Journal of Indian Association of Pediatric Surgeons
|August 7, 2026
Summary
New guidelines address differences of sexual development (DSD) in India, balancing medical needs with cultural and legal factors. These India-specific recommendations ensure ethical, consistent, and child-centered care for DSD management.
Area of Science:
- Endocrinology
- Genetics
- Pediatrics
- Medical Ethics
- Public Health Policy
Background:
- Differences of sexual development (DSD) management in India faces challenges from sociocultural norms, legal issues, delayed diagnosis, and fragmented care.
- Existing international guidelines often do not align with India's specific healthcare and societal context.
Purpose of the Study:
- To create India-specific, ethical, and practical consensus guidelines for managing children with DSD.
- To balance medical requirements, child rights, parental concerns, and legal responsibilities in DSD care.
Main Methods:
- A modified Delphi process involving 23 multidisciplinary experts.
- Iterative rounds of anonymized deliberation and consensus-building.
- Formal ratification by the Government of India after administrative vetting.
Main Results:
- Consensus reached on standardized terminology, diagnostic pathways, sex assignment, intervention timing, and psychosocial support.
- Establishment of Local Multidisciplinary Committees with escalation to state and national levels.
- Emphasis on regulated, indication-based interventions and informed parental consent.
Conclusions:
- India-specific guidelines offer a uniform, ethical, and legally sound framework for DSD management.
- The guidelines integrate multidisciplinary care with sociocultural realities for balanced child welfare.
- Promotes consistent, accountable, and acceptable DSD care across India.
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